Many conditions can cause pain in the sternum, including injuries, pneumonia, bronchitis, and costochondritis. Gastrointestinal problems, such as acid reflux, can cause pain behind the sternum.

People may believe that their sternum pain is a heart attack symptom. However, it is possible to differentiate the two.

In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems.

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The sternum is a flat T-shaped bone that sits at the front of the chest and connects to the ribs with cartilage. It forms part of the rib cage, a series of bones that protect the heart and lungs from injuries.

People often refer to the sternum as the breastbone.

Sternum pain can result from problems with muscles and bones near the sternum, as well as the sternum itself.

Substernal pain is discomfort occurring behind or below the sternum. It often results from gastrointestinal conditions.

Some of the causes of sternum and substernal pain are:

  • costochondritis
  • sternum fracture
  • sternoclavicular joint injury
  • collarbone injuries
  • muscular strain or bruise
  • hernia
  • acid reflux
  • pleurisy
  • bronchitis
  • pneumonia

Costochondritis is inflammation of the cartilage between the sternum and ribs. The medical term for this area is the costochondral joint.

The symptoms of costochondritis include:

  • sharp pain on the side of the sternum area
  • pain that worsens with a deep breath or a cough
  • discomfort in the ribs

Inflammation in the costochondral joint may occur due to injury, infection, or irritation. A person may experience costochondritis due to:

  • impact trauma
  • respiratory tract infections
  • severe coughing
  • physical strains

Like fractures in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury.

People who believe they may have a sternum fracture should seek immediate medical attention in case of additional damage to the heart and lungs.

Symptoms of a sternum fracture include:

The sternoclavicular joint connects the top of the sternum to the collarbone. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area.

People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:

  • mild pain or swelling in the upper chest area
  • difficulty or pain when moving the shoulder
  • popping joints or clicking around the joint

The collarbone connects to the top corners of the sternum by cartilage. Due to the direct connection between the two structures, injuries to the collarbone may cause pain in the sternum area.

Collarbone trauma

Impact and stress trauma can damage, or even fracture, a person’s collarbone. Collarbone trauma may affect its connection to the sternum and the surrounding musculature. This may mean a person feels pain either in or around their sternum.

Depending on the location of collarbone trauma, other symptoms may include:

  • severe pain when raising the arm
  • bruising or swelling in the upper chest area
  • abnormal positioning or sagging of the shoulder
  • clicking and grinding in the shoulder joint

Many muscles connect to the sternum and ribs. Injuries or trauma can result in bruising these muscles, which may cause them to ache. Strenuous or repetitive movements can also cause strains in these muscles.

Learn more about muscle strains here.

Most hernias occur in the abdomen. However, a hiatal hernia can affect the chest area and cause substernal pain.

A hiatal hernia occurs when the stomach moves past the diaphragm and into the chest. Symptoms of a hiatal hernia include:

A person may also vomit blood and have a feeling of fullness.

People with substernal pain and symptoms of a hiatal hernia should see a doctor for prompt treatment.

Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD).

Acid reflux may cause substernal pain and discomfort in the chest.

Pain in this region can also result from inflammation or a spasm of the esophagus. People with GERD should talk with their doctor about preventing further damage to this area.

Learn the difference between heartburn, acid reflux, and GERD here.

Pleura are sheets of tissue between the lungs and ribcage. Inflammation to these tissues is pleurisy.

Pleurisy can cause a sharp, stabbing pain at the site of irritation, which may worsen if a person breathes deeply, coughs, or wheezes.

If inflammation occurs toward the upper middle chest, pleurisy may cause substernal pain.

Bronchitis is the inflammation of the primary airways of the lungs. The condition can cause:

Inflammation of the primary airways may cause substernal pain.

Pneumonia is a common lung infection that causes air sacs in the lungs to inflame and fill with fluid. The medical term for these air sacs is alveoli.

Pneumonia can cause sharp chest pains, which a person may feel behind their sternum.

Other symptoms of pneumonia include.

Infectious bacteria, viruses, and fungi can cause pneumonia.

Depending on the underlying cause of sternum pain, other symptoms that may accompany it include:

  • pain or discomfort in the ribs
  • pain that worsens during deep breathing or coughing
  • mild, aching pain in the upper chest
  • swelling in the upper chest
  • stiffness in the shoulder joints
  • severe pain when raising the arms
  • signs of collarbone trauma, such as bruising or swelling
  • difficulty breathing
  • grinding or popping sensation in joints near the sternum
  • frequent belching
  • heartburn
  • feeling too full
  • throwing up blood

People experiencing chest or sternum pain may worry they are having a heart attack.

A heart attack may potentially occur with the following symptoms:

It is also associated with the following risk factors:

  • being a smoker
  • having high blood pressure
  • having high cholesterol
  • having diabetes
  • having overweight or obesity
  • being a male
  • being aged 65 or over

If a person has sternum pain and is concerned about a heart attack, especially if they are experiencing the above symptoms or have the above risk factors, they should seek immediate medical attention.

While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention.

A person should seek emergency medical attention if the pain:

  • started as a result of direct trauma
  • is accompanied by heart attack symptoms
  • is persistent and does not improve over time
  • is accompanied by intense vomiting or vomiting blood

A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time.

Below are some common questions about sternum pain.

How can a person get rid of breastbone pain?

Treatment for breastbone pain will depend on the underlying cause of the pain. Over-the-counter pain relief may help a person manage symptoms, but they should contact a doctor for a diagnosis if the pain does not improve with time.

What does breastbone pain feel like?

Pain in the breastbone may vary depending on the underlying cause. It may appear suddenly, be a mild ache, or worsen when coughing, deep breathing, eating, or lying down. A person may also feel a sharp, burning, or gnawing sensation, like someone is sitting on their chest, or giving them a tight hug.

What causes chest pain under the ribs?

A wide range of causes, including injuries, can lead to pain under the ribs. People should speak with a healthcare professional for a proper diagnosis.

Can slouching cause sternum pain?

It is possible that slouching causes sternum pain. According to a 2021 case study, excessive sitting and a slouched posture caused one person to experience pain in the neck, upper back, and sternum area. Ultimately, this led to the person developing upper crossed syndrome.

Can heavy lifting cause sternum pain?

Yes, heavy lifting may cause sternum pain. Costochondritis is a temporary condition that can cause pain on the side of the sternum area. It can be caused by heavy lifting or strenuous exercise.

Physical trauma, costochondritis, and muscle strains are common causes of sternum pain.

Conditions such as pneumonia, pleurisy, and GERD can also cause pain in nearby tissue that people may mistake for sternum pain.

While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention.

A person should seek emergency medical attention if the pain:

  • started as a result of direct trauma
  • is accompanied by heart attack symptoms
  • is persistent and does not improve over time
  • is accompanied by intense vomiting or vomiting blood

A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time.

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